Background

Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has 2 elements that are distinct from standard care: early detection and phase-specific treatment (phase-specific treatment is a psychological, social, or physical treatment developed, or modified, specifically for use with people at an early stage of the illness).

Early detection and phase-specific treatment may both be offered as supplements to standard care or may be provided through a specialized early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe, and Australasia.

Objectives

To evaluate the effects of: (a) early detection, (b) phase-specific treatments, and (c) specialized early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis.

Search Methods

We searched the Cochrane Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews, and contacted experts in the field.

Selection Criteria

We included all randomized controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms or to improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific treatments, and care from specialized early intervention teams. We accepted cluster-randomized trials but excluded nonrandomized trials.

Data Collection and Analysis

We reliably selected studies, quality rated them, and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% CIs. Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis.

Authors' Conclusions

There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialized early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials. Full details are published in the Cochrane Review.1

Funding

The original version of the review was funded by a grant in 2000 from the NHS Nationally Commissioned R&D Programme.

Acknowledgments

The authors have declared that there are no conflicts of interest in relation to the subject of this study.